Is Rituximab Effective in Refractory Status Epilepticus

Publish Year: 1398
نوع سند: مقاله کنفرانسی
زبان: English
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EPILEPSEMED16_039

تاریخ نمایه سازی: 28 بهمن 1398

Abstract:

Background: Refractory status epilepticus (RSE) is a life-threatening conditions that lasting more than 60 min and do not respond to first and second-line anticonvulsant drug therapy. How often RSE occurs, the effect of rituximab to control seizure on clinical outcome is poorly defined (1). Methods: In this review, a general search in Medline, Science Direct and Springer databases were done during years of 2004 to 2019. We evaluated human studies of NCS and NCSE in critically ill patients and the results are presented here. Chen JW and et al studies during self-sustaining status epilepticus showed that a depletion occurs in hippocampus of the predominantly inhibitory peptides dynorphin, galanin, somatostatin, and neuropeptide Y, whereas the expression of the proconvulsant substance P and neurokinin B is increased, in cells that do not normally express them at detectable concentrations (2).The recent discovery by Shorvon S and et al showed that Super‐refractory status epilepticus can be due to anti‐NMDA‐receptor antibodies and the recognition that this is a common condition has stimulated interest in the possibility that other, as yet undiscovered, antibodies may be playing a part in the pathogenesis of SE (3). سFindings: Many of the most refractory cases of SE seem to occur in young adults who present with new-onset refractory SE which often appears to have an inflammatory or autoimmune etiology. NMDA-receptor (N-methyl-D-aspart) and Voltage-gated potassium channels (VGKCs)-antibody receptor can cause encephalitis (4). During the refractory SE cytokine levels include interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-10, IL12 is raised (5). Rituximab is an anti-CD20 chimeric monoclonal antibody that results in B-cell depletion and decreased IL-10 level with anti-NMDA effect. The mechanisms of rituximab include not only delayed antibody depleting effects but also direct B cell modulating effects, and it is possible that the reconstitution of B cells after one dose of rituximab generates long lasting changes to the circulating B cell population (6). Rituximab with dose of 1g two weeks apart, with 1 g repeated six and twelve months later (and planned re-treatment at 18 months) abated seizure after 2 weeks of initiation (6).Thus it can help to improve clinical and cognitive impairment in refractory SE.Conclusion: Despite the retrospective nature of this study, our findings support an off-label use of rituximab, with the consideration risk of infectious complications, we suggest that rituximab could be used to reduce significant morbidity and mortality in RSE.

Authors

Shayesteh Gheibi

Fellowship of critical care pharmacotherapy, department of pharmacotherapy in SINA hospital, Tehran university of Medical science,Tehran, Iran

Monireh Ghazaeian

Pharmacotherapist, Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran